Collette Scruggs

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

13337 Issued in NC

Practice address

2418 S Lafayette St
Shelby, NC 28152-7579

Phone

(704) 751-8862

NPI assigned

Nov 10, 2016

Last updated

Jun 23, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1184166944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2418 S LAFAYETTE ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281527579",
            "telephone_number": "704-751-8862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2418 S LAFAYETTE ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281527579",
            "telephone_number": "704-751-8862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCRUGGS",
        "first_name": "COLLETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-10",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-22922",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "22922",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "13337",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "20274",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCSAPPB",
            "identifier": "LCAS-22922",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCBLCMHC",
            "identifier": "13337",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vishmayaa Saravanan, MD
• Dan R Sarratt, CRNA
• Joniah Damorney Sauberan, LCMHCA, LPC
• Amy Saxton, FNP
• Erik L Schuls, MD
• Lydia Perrin Scruggs, LCSW
• Lynn Etters Scruggs, RPH
• Emily Sealey, PTA
• Second Chance Outreach Services
• Second Chance Recovery Center Inc.

• Mental Health Counselor in Shelby, NC
• Providers in Shelby, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.